1205239407 NPI number — MRS. PAGE BAILEY MEACHUM RD, CSP, LD

Table of content: MRS. PAGE BAILEY MEACHUM RD, CSP, LD (NPI 1205239407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205239407 NPI number — MRS. PAGE BAILEY MEACHUM RD, CSP, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEACHUM
Provider First Name:
PAGE
Provider Middle Name:
BAILEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CSP, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILEY
Provider Other First Name:
PAGE
Provider Other Middle Name:
CARRERE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205239407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6651 AINTREE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75214-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-231-9648
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1935 MEDICAL DISTRICT DR
Provider Second Line Business Practice Location Address:
CLINICAL NUTRITION
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-456-2133
Provider Business Practice Location Address Fax Number:
214-456-6287
Provider Enumeration Date:
10/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1004X , with the licence number:  DT83443 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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